Provider Demographics
NPI:1952937468
Name:ALPHA NUTRITION & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ALPHA NUTRITION & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKWOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-538-8696
Mailing Address - Street 1:801 LOCUST GROVE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1157
Mailing Address - Country:US
Mailing Address - Phone:678-537-1068
Mailing Address - Fax:478-419-3990
Practice Address - Street 1:11130 STATE BRIDGE RD STE E101
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-2641
Practice Address - Country:US
Practice Address - Phone:678-538-8696
Practice Address - Fax:478-419-3990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA NUTRITION & WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty